title: Outbreak report: nosocomial transmission of measles through an unvaccinated healthcare worker-implications for public health.
abstract: BACKGROUND
  Nosocomial transmission of measles is a near avoidable event with the potential for serious sequelae. Those who acquire infection in hospitals may be particularly susceptible to serious disease. UK guidance recommends measles, mumps, rubella vaccine (MMR) vaccination for healthcare workers (HCWs) as a key preventative measure against nosocomial transmission. We report an incident of transmission of measles from a patient to an unvaccinated HCW, with subsequent onward transmission to a patient in a paediatric unit.
  
  
  METHODS
  Response to the incident was undertaken in accordance with guidance from the Health Protection Agency (now Public Health England) and UK Department of Health.
  
  
  RESULTS
  The index case had travelled to France, where there was an ongoing outbreak. There were 110 contacts identified for this HCW, of whom 61 were advised to have MMR and 5 were given immunoglobulin. All three cases were found to have the same D4 genotype.
  
  
  CONCLUSIONS
  The report highlights the large number of potential contacts in a hospital setting and the time and resource implications involved to prevent further cases. It also highlights the importance of timely identification of measles, early public health notification and complete contact tracing. Such incidents are nearly avoidable given the availability of an efficacious vaccine.
authors.affiliation: Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LG, UK.
authors.forename: Ruchi
authors.initials: R
authors.lastname: Baxi
authors.affiliation: Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LG, UK.
authors.forename: Oliver T
authors.initials: OT
authors.lastname: Mytton
authors.affiliation: Thames Valley Public Health England Centre, Public Health England, Chilton, Didcot, Oxon OX11 0RQ, UK.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Abid
authors.affiliation: South East London Health Protection Team, Public Health England London, 1 Lower Marsh, London SE1 7NT, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Maduma-Butshe
authors.affiliation: Royal Berkshire Hospital, Foundation Trust, London Road, Reading RG1 5AN, UK.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Iyer
authors.affiliation: Royal Berkshire Hospital, Foundation Trust, London Road, Reading RG1 5AN, UK.
authors.forename: Anyanate
authors.initials: A
authors.lastname: Ephraim
authors.affiliation: Virus Reference Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Brown
authors.affiliation: Thames Valley Public Health England Centre, Public Health England, Chilton, Didcot, Oxon OX11 0RQ, UK.
authors.forename: Éamonn
authors.initials: É
authors.lastname: O'Moore
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000635:transmission* / Q000821:virology; D004196:Disease Outbreaks; D006282:Health Personnel; D006801:Humans; D007223:Infant; D017757:Infectious Disease Transmission, Professional-to-Patient; D008457:Measles / Q000635:transmission*; D008458:Measles Vaccine / Q000627:therapeutic use*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D008458:Measles Vaccine
keywords: MMR; healthcare worker; measles; nosocomial infection; outbreak; vaccination